The list of medical tests mentioned in various sources as used in the diagnosis of Necrotizing fasciitis includes:
Neocrotizing fasciitis is diagnosed by either blood cultures or aspiration of pus from tissue. Surgical exploration may be necessary. (Source: excerpt from Group A Streptococcal Infections, NIAID Fact Sheet: NIAID)
The following medical news items are relevant to diagnosis and misdiagnosis issues for Necrotizing fasciitis:
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Routine orders include a CBC, sedimentation rate, chemistry panel, VDRL test, serum protein electrophoresis, ANA titer, and glucose tolerance test. The gangrenous area should be cultured. Plain x-rays of the area sometimes are helpful. If there are diminished pulses, especially if the onset is acute, angiography will be useful. A muscle biopsy or skin biopsy will be useful in diagnosing collagen diseases. The Sia water test and serum immunoelectrophoresis will be useful in diagnosing macroglobulinemia and cryoglobulinemia.
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Tissue biopsy is the best method of diagnosing necrotizing fasciitis. Cultures of microorganisms can be obtained locally from the periphery of the spreading infection or from deeper tissues during surgical debridement. Gram's staining and culturing of biopsied tissue are useful in establishing the type of invasive organisms and the effective treatment against them.
Radiographic studies can pinpoint the presence of subcutaneous gases, and computed tomography scans can locate the anatomic site of involvement by locating the necrosis. In combination with clinical assessment, magnetic resonance imaging determines areas of necrosis and the need for surgical debridement.
Other supportive studies include laboratory values such as complete blood count with differential, electrolytes, glucose, blood urea nitrogenand creatinine, urinalysis, and arterial blood gas levels.
Other conditions to consider in the differential diagnosis include cellulitis, testicular torsion, epididymitis and orchitis (as related to Fournier's gangrene), gas gangrene, hernias, and toxic shock syndrome (TSS).
Source: Professional Guide to Diseases (Eighth Edition), 2005
All patients should have a CBC, sedimentation rate, venereal disease research laboratory (VDRL) test, chemistry panel, and serum protein electrophorosis. In cases of the Raynaud phenomenon, an ANA and RA titer should also be done. Aerobic and anaerobic cultures of exudates from the wound should also be taken. Plain x-rays of the area involved are recommended. If an embolism or obstruction of the large arteries is suspected, contrast angiography needs to be done. An ice water test, Sia water test, and serum immunoelectrophoresis will be useful in cases of the Raynaud phenomenon. A rheumatology consult is wise.
Source: Differential Diagnosis in Primary Care, 2007
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